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Family Planning

Revised: 01-08-2016

This section includes MHCP coverage and billing policy for family planning services. Refer to the Reproductive Health/OB-GYN overview page for links to other related services and the Minnesota Family Planning Program (MFPP).

MHCP family planning services cover services and supplies for men and women of childbearing age, including minors. The following considerations apply:

  • • Recipients must be free of coercion and free to choose the method of family planning they want to use.
  • • Providers cannot require that an unmarried minor’s parent or guardian consent to family planning services for the minor.
  • • Family planning services have no copays.
  • Confidentiality

    Family planning services do not appear on any explanations of medical benefits (EMOBs) to the recipient or recipient’s family. Recipients may choose to receive notices at an address other than a home address.

    Eligible Providers

    The following MHCP-enrolled providers may provide some or all of the available family planning services and supplies:

  • • Certified nurse midwives
  • • Certified nurse practitioners
  • • Clinical nurse specialists
  • • Clinics
  • Family planning agencies
  • • Outpatient hospital departments
  • • Pharmacies
  • • Physician assistants
  • • Physicians
  • Dispensing by Protocol – Family Planning Registered Nurse

    Effective for dates of service on and after July 1, 2007, a registered nurse (RN) in a family planning agency may dispense oral contraceptives prescribed by a licensed practitioner, according to a dispensing protocol established by the agency’s medical director or under the direction of a physician. RNs may not dispense oral contraception to a recipient who is less than 12 years old. Follow state requirements for dispensing prescription drugs.

    Refer to the applicable sections for information and requirements relevant to the various providers.

    Free Choice of Provider

    All MHCP recipients have free choice of family planning providers and may obtain covered family planning services from any qualified provider, including those outside of their provider network.

    If a provider furnishes a family planning service to a managed care recipient and that provider is not part of the recipient’s health plan provider network, the provider must contact the health plan for payment.

    Eligible Recipients

    All MHCP recipients, except Emergency Medical Assistance (EMA) recipients, of childbearing age, including minors, are eligible to receive family planning services.

    Covered Services

    The following are covered services for family planning:

  • • Consultation, examination, and medical treatment
  • • Contraceptive devices (e.g., diaphragm, intrauterine device [IUD])
  • • Contraceptive injections (e.g., Depo-Provera)
  • • Emergency contraception (e.g., Plan B)
  • • Family planning counseling
  • • Family planning supplies (e.g., condoms, thermometers)
  • • Genetic counseling (refer to Physician Extender section)
  • • HIV blood screening and counseling (performed before and after HIV blood screening test)
  • • Infertility services, limited to diagnosis and treatment of medical problems causing infertility (e.g., pituitary or ovarian tumor, testicular mass)
  • • Laboratory examination and tests, including screening for cervical cancer by Pap smear and pregnancy testing as clinically indicated
  • • Prescriptions for the purpose of family planning
  • • Testing of sexually transmitted infections (STIs)
  • • Treatment of no HIV-related STIs
  • • Voluntary sterilization (refer to Sterilization section);
  • Recipients enrolled in managed care organizations must seek treatment for HIV/AIDS or infertility treatment through their managed care network.

    Refer to the HIV/AIDS web resources page for information about treatment for fee-for-service recipients.

    Not all covered family planning services are directly provided by family planning providers. Recipients must be fully informed of, and consent freely to, all family planning services.

    Noncovered Services

    MHCP does not cover the following services:

  • • Artificial insemination, including in vitro fertilization
  • • Fertility drugs and all associated services
  • • Reversal of voluntary sterilization
  • Billing

    Refer to the following when billing for family planning services:

  • • Use the MN–ITS 837P
  • • Pharmacies: Bill point of sale (POS) for drugs; use the 837P for supplies and devices
  • • Indian Health Services, family planning agencies and community health clinics (CHCs) dispensing oral contraceptives use the following codes:
  • • Oral contraceptives and hormonal emergency contraceptives: use HCPCS code S4993. Bill up to a three-month supply (3 units)
  • • Non-hormonal emergency contraceptives: use procedure code J8499 and diagnosis code Z30.012 to bill emergency contraceptives when billing MFPP; use J3490 when billing MA or MinnesotaCare.
  • • If you provide oral contraceptive products (OCPs) and emergency contraceptives (ECs) on the same date of service, list OCPs on one claim line and list EC on a different claim line
  • • For genetic counseling, refer to the special billing instructions in the Physician Extender section
  • Definitions

    Family Planning Service
    A family planning service includes screening, testing, and counseling for sexually transmitted diseases, such as HIV, when provided in conjunction with the voluntary planning of conception and childbearing, and related to a recipient’s condition of fertility.

    Family Planning Supply
    A family planning supply is a prescribed drug or contraceptive device ordered by a physician or other eligible provider with prescribing authority for treatment of a condition related to a family planning service.

    Family Planning Agency
    A family planning agency is an entity having a medical director that provides family planning services under the direction of an MHCP-enrolled physician. The medical director must ensure that trained personnel perform the counseling and provide information about family planning according to accepted community standards.

    Legal References

    Minnesota Session Laws 2007
    Chapter 139 Article 1, section 21, subd., 311
    Dispensing by protocol (registered nurse/family planning)
    Minnesota Statutes 151.01
    , subd. 30 Definitions (Dispense)
    Minnesota Statutes 151.212, subd. 1
    Label of Prescription Drug Containers (Prescription drugs)
    Minnesota Rules 9505.0280
    Family planning services

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